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Emotional changes following brain injury: psychological and neurological components of depression, denial and anxiety

Journal of Rehabilitation, April-June, 1991 by Carol Armstrong

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Robinson and Szetela (1980) examined the occurrence of depression after a unilateral cerebrovascular accident in relation to the location of the injury. They related depression post injury to dysfunction of the frontal lobe in humans (Lipsey, Robinson, Pearlson, Krishna Rao, & Price, 1983, Robinson, 1987, Robinson, Lipsey & Price, 1985). The greater the degree of depression, the closer were the injuries to the left frontal lobe. (Depression was more highly correlated with left than right, anterior than posterior, and left frontal than right frontal injuries.) A study (Ahern & Schwartz, 1985) of the localization of emotion in uninjured brains provided interesting evidence of the brain's organization. The use of EEG spectral analysis revealed that in frontal zones, there was greater left hemisphere activation or positive emotional reactions (e.g., excitement and happiness) and relative right hemisphere activation for negative emotions (e.g., fear and sadness). Although there appear to be conflicting results on laterality of emotion, this disagreement seems to reflect the way emotions are measured. Many studies have found lateralized differences (Ahern & Schwartz, 1979, Schwartz, Ahern & Brown, 1979, Schwartz, Davidson & Maer, 1975, Tucker, 1981, Tucker, Stenslie, Roth & Shearer, 1981), and most studies have linked the mediation of negative and positive emotions to the right and left hemispheres respectively. However, a new thrust in the study of the laterality of emotion and psypathology is the linkage of depression with posterior right hemisphere injuries (Finset, Goffeng, Landro, & Haakonsen, 1989). Another functionally-based dynamic may be the relative left and right contributions to excitation and inhibition of emotion, and research is recommended in this area.

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Studies of the lateralization of emotion in non-brain injured and brain injured subjects suggest that depression may result from injury to either hemisphere, although qualitative differences exist. Depression characterized by anxiety, fear, and sometimes agitated, hostile, or aggressive behavior can occur in right hemisphere dysfunction, while depression characterized by sadness, lethargy, and perseverative feelings can occur with left hemisphere dysfunction (Von Knorring, 1983). Injury in one hemisphere not only means that some emotion is not being stimulated, but also that the injured side is not inhibiting the uninjured side and thus is being overriden by the intact frontal hemisphere. In non-brain injured persons, left hemisphere excitation has often been correlated with positive emotions, while the right hemisphere has responded to affective stimuli most often with negative emotions (Davidson & Schaffer, 1983, Sackheim, Greenberg, Weiman, et al., 1982). A more comprehensive review of the literature on lateralization of emotion can be found in Flor-Henry & Gruzelier (1983).

Another aspect of post-injury emotional reactions to be considered is the corter's sensitivity to stimuli from the environment. Changes in the threshold at which stimuli are perceived as well as the degree of pleasantness of the stimuli can easily affect human relationships. In addition, arousal and internal reactivity are necessary for personal expression. The left anterior hemisphere, when injured, has been found to result in dysfluency of thought and word, which makes it difficult for injured persons to express thoughts and feelings in words. They are more likely to experience a catastrophic reaction and, in fact, appear to be more sensitive than those injured in the opposite hemisphere alone. Galvanic Skin Responses (GSR) increase in relation to stimulation, making the stress reaction overly sensitive (Valenstein & Heilman, 1979). In addition, injuries to language expression areas of the frontal lobe can reduce the individual's ability to regulate their orienting reflect and arousal via verbal mediation (Luria, 1964). This has implications for the limited usesfulness of traditional psychotherapy with individuals with these injuries.

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Emotional changes following brain injury: psychological and neurological components of depression, denial and anxiety

Journal of Rehabilitation, April-June, 1991 by Carol Armstrong

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